Introduction: The correlation between diabetes and stroke has been studied extensively in epidemiological research. Here, we used bibliometric software to visualize and analyze the literature related to diabetic stroke to provide an overview of the current state of research, hotspots, and future trends in the field. Methods: Based on the Web of Science Core Collection (WoSCC) database, we collected studies related to diabetic stroke from 2007 to December 2022. We used CiteSpace (version 6.1.R5), VOSviewer, and Scimago Graphica to create knowledge maps and conduct visual analyses on authors, countries, institutions, cited references, and keywords, and Origin for statistical analysis. Results: We included a total of 5,171 papers on diabetic stroke from the WoSCC database. Overall, there was a steady increase in the number of publications, with a high number of emerging scientists. The USA was the most productive and influential country, which dominated national collaborations. The most common subject category was “neurology.” In total, 12 major clusters were generated from the cited references. Keyword analysis showed that keywords related to poststroke injury and treatment are those with the highest burst intensity and latest burst time. Conclusions: Individual disease treatment remains a hot topic, and how to balance acute stroke treatment and glycemic control is currently a difficult clinical problem. At the same time, the mechanism of their interaction and the prevention and treatment of related causative factors remain a hot topic of current and future research.

1.
Lau LH, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: a meta-analysis and literature review. J Diabetes Investig. 2019 May;10(3):780–92.
2.
Emerging Risk Factors Collaboration; Sarwar N, Gao P, Seshasai SRK, Gobin R, Kaptoge S, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.
3.
Chen R, Ovbiagele B, Feng W. Diabetes and stroke: epidemiology, pathophysiology, pharmaceuticals and outcomes. Am J Med Sci. 2016 Apr;351(4):380–6.
4.
Scott JF, Robinson GM, French JM, O’Connell JE, Alberti K, Gray CS. Prevalence of admission hyperglycaemia across clinical subtypes of acute stroke. Lancet. 1999;353(9150):376–7.
5.
Fisher M, Feuerstein G, Howells DW, Hurn PD, Kent TA, Savitz SI, et al. Update of the stroke therapy academic industry roundtable preclinical recommendations. Stroke. 2009 Jun;40(6):2244–50.
6.
Bruno A, Levine SR, Frankel MR, Brott TG, Lin Y, Tilley BC, et al. Admission glucose level and clinical outcomes in the NINDS rt-PA Stroke Trial. Neurology. 2002 Sep 10;59(5):669–74.
7.
Zhang C, Zhou YH, Xu CL, Chi FL, Ju HN. Efficacy of intensive control of glucose in stroke prevention: a meta-analysis of data from 59,197 participants in 9 randomized controlled trials. PLoS One. 2013;8(1):e54465.
8.
Bellolio MF, Gilmore RM, Ganti L. Insulin for glycaemic control in acute ischaemic stroke. Cochrane Database Syst Rev. 2014 Jan 23(1):CD005346.
9.
Johnston KC, Bruno A, Pauls Q, Hall CE, Barrett KM, Barsan W, et al. Intensive vs standard treatment of hyperglycemia and functional outcome in patients with acute ischemic stroke: the SHINE randomized clinical trial. JAMA. 2019 Jul 23;322(4):326–35.
10.
Jiang M, Qi Y, Liu H, Chen Y. The role of nanomaterials and nanotechnologies in wastewater treatment: a bibliometric analysis. Nanoscale Res Lett. 2018;13(1):233.
11.
Thompson DF, Walker CK. A descriptive and historical review of bibliometrics with applications to medical sciences. Pharmacotherapy. 2015 Jun;35(6):551–9.
12.
Kim Y, Jang SN. Mapping the knowledge structure of frailty in journal articles by text network analysis. PLoS One. 2018;13(4):e0196104.
13.
Yu Y, Li Y, Zhang Z, Gu Z, Zhong H, Zha Q, et al. A bibliometric analysis using VOSviewer of publications on COVID-19. Ann Transl Med. 2020 Jul;8(13):816.
14.
Wang F, Jia X, Wang X, Zhao Y, Hao W. Particulate matter and atherosclerosis: a bibliometric analysis of original research articles published in 1973-2014. BMC Public Health. 2016 Apr 19;16:348.
15.
Wang W, Lu C. Visualization analysis of big data research based on Citespace. Soft Comput. 2019;24(11):8173–86.
16.
Kokol P, Blažun Vošner H, Završnik J. Application of bibliometrics in medicine: a historical bibliometrics analysis. Health Info Libr J. 2021 Jun;38(2):125–38.
17.
de Castilhos Ghisi N, Zuanazzi NR, Fabrin TMC, Oliveira EC. Glyphosate and its toxicology: a scientometric review. Sci Total Environ. 2020 Sep 1;733:139359.
18.
Xu D, Wang YL, Wang KT, Wang Y, Dong XR, Tang J, et al. A scientometrics analysis and visualization of depressive disorder. Curr Neuropharmacol. 2021;19(6):766–86.
19.
Chen C. Searching for intellectual turning points: progressive knowledge domain visualization. Proc Natl Acad Sci U S A. 2004 Apr 6;101(Suppl 1):5303–10.
20.
van Eck NJ, Waltman L. Software survey: VOSviewer, a computer program for bibliometric mapping. Scientometrics. 2010 Aug;84(2):523–38.
21.
Lin M, Chen Y, Chen R. Time matters greatly in acute stroke care. Neurol Neurochir Pol. 2020;54(2):104–5.
22.
Li H, An H, Wang Y, Huang J, Gao X. Evolutionary features of academic articles co-keyword network and keywords co-occurrence network: based on two-mode affiliation network. Phys Stat Mech Appl. 2016;450:657–69.
23.
Kokol P, Kokol M, Zagoranski S. Machine learning on small size samples: a synthetic knowledge synthesis. Sci Prog. 2022 Jan-Mar;105(1):368504211029777.
24.
Zhao X, He X, Xi B, Gao R, Tan W, Zhang H, et al. A scientometric review of global BIM research: analysis and visualization. Waste Manag. 2017;70:37–44.
25.
Zhou Q, Kong HB, He BM, Zhou SY. Bibliometric analysis of bronchopulmonary dysplasia in extremely premature infants in the Web of science database using CiteSpace software. Front Pediatr. 2021;9:705033.
26.
Chen C, Ibekwe-SanJuan F, Hou J. The structure and dynamics of cocitation clusters: a multiple-perspective cocitation analysis. J Am Soc Inf Sci Technol. 2010;61(7):1386–409.
27.
Liu S, Sun YP, Gao XL, Sui Y. Knowledge domain and emerging trends in Alzheimer’s disease: a scientometric review based on CiteSpace analysis. Neural Regen Res. 2019 Sep;14(9):1643–50.
28.
Prakash R, Li W, Qu Z, Johnson MA, Fagan SC, Ergul A. Vascularization pattern after ischemic stroke is different in control versus diabetic rats: relevance to stroke recovery. Stroke. 2013 Oct;44(10):2875–82.
29.
Gray CS, Hildreth AJ, Sandercock PA, O’Connell JE, Johnston DE, Cartlidge NEF, et al. Glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK glucose insulin in stroke trial (GIST-UK). Lancet Neurol. 2007;6(5):397–406.
30.
Adams HPJr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke. 2007 May;38(5):1655–711.
31.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2018 Mar;49(3):e46–110.
32.
Luitse MJA, Biessels GJ, Rutten GEHM, Kappelle LJ. Diabetes, hyperglycaemia, and acute ischaemic stroke. Lancet Neurol. 2012;11(3):261–71.
33.
Wardlaw JM, Smith EE, Biessels GJ, Cordonnier C, Fazekas F, Frayne R, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration. Lancet Neurol. 2013;12(8):822–38.
34.
Amarenco P, Bogousslavsky J, Callahan A3rd, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006 Aug 10;355(6):549–59.
35.
Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med. 2020 May 14;382(20):e60.
36.
Kamada H, Yu F, Nito C, Chan PH. Influence of hyperglycemia on oxidative stress and matrix metalloproteinase-9 activation after focal cerebral ischemia/reperfusion in rats: relation to blood-brain barrier dysfunction. Stroke. 2007 Mar;38(3):1044–9.
37.
Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. The Lancet. 2016;387(10029):1723–31.
38.
Jauch EC, Saver JL, Adams HPJr, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013 Mar;44(3):870–947.
39.
Investigators N-SS, Finfer S, Chittock DR, Su SY, Blair D, Foster D, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009 Mar 26;360(13):1283–97.
40.
Bruno A, Kent TA, Coull BM, Shankar RR, Saha C, Becker KJ, et al. Treatment of hyperglycemia in ischemic stroke (THIS): a randomized pilot trial. Stroke. 2008 Feb;39(2):384–9.
41.
Chen Y, Lin M, Zhuang D. Wastewater treatment and emerging contaminants: bibliometric analysis. Chemosphere. 2022 Jun;297:133932.
42.
Zhong M, Lin M. Bibliometric analysis for economy in COVID-19 pandemic. Heliyon. 2022 Sep;8(9):e10757.
43.
Lu FP, Lin KP, Kuo HK. Diabetes and the risk of multi-system aging phenotypes: a systematic review and meta-analysis. PLoS One. 2009;4(1):e4144.
44.
Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association/american stroke association. Stroke. 2011 Sep;42(9):2672–713.
45.
Abdul Y, Li W, Ward R, Abdelsaid M, Hafez S, Dong G, et al. Deferoxamine treatment prevents post-stroke vasoregression and neurovascular unit remodeling leading to improved functional outcomes in type 2 male diabetic rats: role of endothelial ferroptosis. Transl Stroke Res. 2021 Aug;12(4):615–30.
46.
Shukla V, Shakya AK, Perez-Pinzon MA, Dave KR. Cerebral ischemic damage in diabetes: an inflammatory perspective. J Neuroinflammation. 2017 Jan 23;14(1):21.
47.
Iwata N, Okazaki M, Rika N, Kasahara C, Kamiuchi S, Suzuki F, et al. Diabetes-mediated exacerbation of neuronal damage and inflammation after cerebral ischemia in rat: protective effects of water-soluble extract from culture medium of ganoderma lucidum mycelia; 2012.
48.
Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in wuhan, China. JAMA Neurol. 2020 Jun 1;77(6):683–90.
49.
Batinić-Haberle I, Rebouças JS, Spasojević I. Superoxide dismutase mimics: chemistry, pharmacology, and therapeutic potential. Antioxid Redox Signal. 2010 Sep;13(6):877–918.
50.
Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol JP, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006 Apr 12;295(14):1681–7.
51.
Wentholt IM, Kulik W, Michels RP, Hoekstra JB, DeVries JH. Glucose fluctuations and activation of oxidative stress in patients with type 1 diabetes. Diabetologia. 2008 Jan;51(1):183–90.
52.
Wright RJ, Frier BM. Vascular disease and diabetes: is hypoglycaemia an aggravating factor?Diabetes Metab Res Rev. 2008;24(5):353–63.
53.
Madjid M, Naghavi M, Litovsky S, Casscells SW. Influenza and cardiovascular disease: a new opportunity for prevention and the need for further studies. Circulation. 2003 Dec 2;108(22):2730–6.
54.
Schram MT, Chaturvedi N, Schalkwijk CG, Fuller JH, Stehouwer CD; EURODIAB Prospective Complications Study Group. Markers of inflammation are cross-sectionally associated with microvascular complications and cardiovascular disease in type 1 diabetes: the EURODIAB Prospective Complications Study. Diabetologia. 2005 Feb;48(2):370–8.
55.
Sun J, Wang F, Ling Z, Yu X, Chen W, Li H, et al. Clostridium butyricum attenuates cerebral ischemia/reperfusion injury in diabetic mice via modulation of gut microbiota. Brain Res. 2016 Jul 1;1642:180–8.
56.
Li S, Sun X, Xu L, Sun R, Ma Z, Deng X, et al. Baicalin attenuates in vivo and in vitro hyperglycemia-exacerbated ischemia/reperfusion injury by regulating mitochondrial function in a manner dependent on AMPK. Eur J Pharmacol. 2017 Nov 15;815:118–26.
57.
Kapadia R, Yi JH, Vemuganti R. Mechanisms of anti-inflammatory and neuroprotective actions of PPAR-gamma agonists. Front Biosci. 2008 Jan 1;13:1813–26.
58.
Luo Y, Yin W, Signore AP, Zhang F, Hong Z, Wang S, et al. Neuroprotection against focal ischemic brain injury by the peroxisome proliferator-activated receptor-gamma agonist rosiglitazone. J Neurochem. 2006 Apr;97(2):435–48.
59.
Tureyen K, Kapadia R, Bowen KK, Satriotomo I, Liang J, Feinstein DL, et al. Peroxisome proliferator-activated receptor-gamma agonists induce neuroprotection following transient focal ischemia in normotensive, normoglycemic as well as hypertensive and type-2 diabetic rodents. J Neurochem. 2007 Apr;101(1):41–56.
60.
Song YS, Narasimhan P, Kim GS, Jung JE, Park EH, Chan PH. The role of Akt signaling in oxidative stress mediates NF-kappaB activation in mild transient focal cerebral ischemia. J Cereb Blood Flow Metab. 2008 Dec;28(12):1917–26.
61.
Andersen KK, Olsen TS, Dehlendorff C, Kammersgaard LP. Hemorrhagic and ischemic strokes compared: stroke severity, mortality, and risk factors. Stroke. 2009 Jun;40(6):2068–72.
62.
Sawabe M. Vascular aging: from molecular mechanism to clinical significance. Geriatr Gerontol Int. 2010 Jul;10(Suppl 1):S213–20.
63.
Vemuri P, Lesnick TG, Przybelski SA, Knopman DS, Lowe VJ, Graff-Radford J, et al. Age, vascular health, and Alzheimer disease biomarkers in an elderly sample. Ann Neurol. 2017 Nov;82(5):706–18.
64.
Batta Y, King C, Johnson J, Haddad N, Boueri M, Haddad G. Sequelae and comorbidities of COVID-19 manifestations on the cardiac and the vascular systems. Front Physiol. 2021;12:748972.
65.
Qiu C, Sigurdsson S, Zhang Q, Jonsdottir MK, Kjartansson O, Eiriksdottir G, et al. Diabetes, markers of brain pathology and cognitive function: the Age, Gene/Environment Susceptibility-Reykjavik Study. Ann Neurol. 2014 Jan;75(1):138–46.
66.
Laing SP, Swerdlow AJ, Carpenter LM, Slater SD, Burden AC, Botha JL, et al. Mortality from cerebrovascular disease in a cohort of 23 000 patients with insulin-treated diabetes. Stroke. 2003 Feb;34(2):418–21.
67.
Sundquist K, Li X. Type 1 diabetes as a risk factor for stroke in men and women aged 15-49: a nationwide study from Sweden. Diabet Med. 2006 Nov;23(11):1261–7.
68.
Maggio CA, Pi-Sunyer FX. Obesity and type 2 diabetes. Endocrinol Metab Clin North Am. 2003;32(4):805–22, viii.
69.
Grundy SM, Hansen B, Smith SCJr, Cleeman JI, Kahn RA; American Heart Association, et al. Clinical management of metabolic syndrome: report of the American heart association national heart, lung, and blood institute/American diabetes association conference on scientific issues related to management. Arterioscler Thromb Vasc Biol. 2004 Feb;24(2):e19–24.
70.
Qureshi AI, Caplan LR. Intracranial atherosclerosis. Lancet. 2014;383(9921):984–98.
71.
Hassan A, Hunt BJ, O’Sullivan M, Parmar K, Bamford JM, Briley D, et al. Markers of endothelial dysfunction in lacunar infarction and ischaemic leukoaraiosis. Brain. 2003 Feb;126(Pt 2):424–32.
72.
Chishaki A, Chishaki H. To know the exact prevalence and prognosis of atrial fibrillation from a clinical survey: comments on the “The Fushimi AF Registry.”J Cardiol. 2013 Apr;61(4):304–6.
73.
Blankenhorn DH, Kramsch DM. Reversal of atherosis and sclerosis. The two components of atherosclerosis. Circulation. 1989 Jan;79(1):1–7.
74.
Weidmann P, Ferrari P. Central role of sodium in hypertension in diabetic subjects. Diabetes Care. 1991 Mar;14(3):220–32.
75.
Khan U, Porteous L, Hassan A, Markus HS. Risk factor profile of cerebral small vessel disease and its subtypes. J Neurol Neurosurg Psychiatry. 2007 Jul;78(7):702–6.
76.
Fanning JP, Wong AA, Fraser JF. The epidemiology of silent brain infarction: a systematic review of population-based cohorts. BMC Med. 2014 Jul 9;12:119.
77.
Mooradian AD. Dyslipidemia in type 2 diabetes mellitus. Nat Clin Pract Endocrinol Metab. 2009 Mar;5(3):150–9.
78.
Sone H, Tanaka S, Tanaka S, Iimuro S, Oida K, Yamasaki Y, et al. Serum level of triglycerides is a potent risk factor comparable to LDL cholesterol for coronary heart disease in Japanese patients with type 2 diabetes: subanalysis of the Japan Diabetes Complications Study (JDCS). J Clin Endocrinol Metab. 2011 Nov;96(11):3448–56.
79.
Saber H, Khatibi K, Szeder V, Tateshima S, Colby GP, Nour M, et al. Reperfusion therapy frequency and outcomes in mild ischemic stroke in the United States. Stroke. 2020 Nov;51(11):3241–9.
80.
Masrur S, Cox M, Bhatt DL, Smith EE, Ellrodt G, Fonarow GC, et al. Association of acute and chronic hyperglycemia with acute ischemic stroke outcomes post-thrombolysis: findings from get with the guidelines-stroke. J Am Heart Assoc. 2015 Sep 25;4(10):e002193.
81.
Kim JT, Jahan R, Saver JL; SWIFT Investigators. Impact of glucose on outcomes in patients treated with mechanical thrombectomy: a post hoc analysis of the solitaire flow restoration with the intention for thrombectomy study. Stroke. 2016 Jan;47(1):120–7.
82.
Diprose WK, Wang MTM, McFetridge A, Sutcliffe J, Barber PA. Glycated hemoglobin (HbA1c) and outcome following endovascular thrombectomy for ischemic stroke. J Neurointerv Surg. 2020 Jan;12(1):30–2.
83.
Murray KN, Parry-Jones AR, Allan SM. Interleukin-1 and acute brain injury. Front Cell Neurosci. 2015;9:18.
84.
Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004 Mar 6;363(9411):768–74.
85.
Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379(9834):2364–72.
86.
Park JM, Kang K, Cho YJ, Hong KS, Lee KB, Park TH, et al. Comparative effectiveness of prestroke aspirin on stroke severity and outcome. Ann Neurol. 2016 Apr;79(4):560–8.
87.
Ryu WS, Schellingerhout D, Hong KS, Jeong SW, Kim BJ, Kim JT, et al. Relation of pre-stroke aspirin use with cerebral infarct volume and functional outcomes. Ann Neurol. 2021 Nov;90(5):763–76.
88.
Harpaz D, Seet RCS, Marks RS, Tok AIY. B-type natriuretic peptide as a significant brain biomarker for stroke triaging using a bedside point-of-care monitoring biosensor. Biosensors. 2020 Aug 26;10(9):107.
89.
Holscher C. Central effects of GLP-1: new opportunities for treatments of neurodegenerative diseases. J Endocrinol. 2014 Apr;221(1):T31–41.
90.
Teramoto S, Miyamoto N, Yatomi K, Tanaka Y, Oishi H, Arai H, et al. Exendin-4, a glucagon-like peptide-1 receptor agonist, provides neuroprotection in mice transient focal cerebral ischemia. J Cereb Blood Flow Metab. 2011 Aug;31(8):1696–705.
91.
Sarkaki A, Farbood Y, Badavi M, Khalaj L, Khodagholi F, Ashabi G. Metformin improves anxiety-like behaviors through AMPK-dependent regulation of autophagy following transient forebrain ischemia. Metab Brain Dis. 2015 Oct;30(5):1139–50.
92.
Fu L, Huang L, Cao C, Yin Q, Liu J. Inhibition of AMP-activated protein kinase alleviates focal cerebral ischemia injury in mice: interference with mTOR and autophagy. Brain Res. 2016 Nov 1;1650:103–11.
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